Provider Demographics
NPI:1164440426
Name:O C H INTERNAL MEDICINE
Entity Type:Organization
Organization Name:O C H INTERNAL MEDICINE
Other - Org Name:OCH INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-504-1910
Mailing Address - Street 1:1215 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1619
Mailing Address - Country:US
Mailing Address - Phone:270-298-5404
Mailing Address - Fax:270-298-5285
Practice Address - Street 1:1215 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-298-5404
Practice Address - Fax:270-298-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG91153OtherMEDICARE UPIN NUMBER
KY65922247Medicaid
KS000000196674OtherBLUE CROSS AND CLUE SHIEL
KY270009Medicare PIN
KS000000196674OtherBLUE CROSS AND CLUE SHIEL